Desfechos de pacientes com versus sem câncer ativo após substituição da valva aórtica transcateter: uma revisão sistemática e metanálise.

Abstract

Patients with active cancer and severe aortic valve stenosis are frequently deemed ineligible for valve interventions due to perceived high risk. However, whether active cancer impacts short- and long-term outcomes after transcatheter aortic valve replacement (TAVR) remains unknown. A systematic search of PubMed, Embase, and Cochrane Library in December 2023 to identify studies comparing the post-TAVR outcomes between patients with and without active cancer. We pooled odds ratios (OR), adjusted hazard ratios (aHR), and mean differences with 95% confidence intervals (CI) applying a random-effects model. Statistical analyses were performed in R software version 4.3.2. A total of 9 observational studies comprising 133,906 patients were included, with 9,792 (7.3%) patients having active cancer. Patients with active cancer, as compared to those without cancer, exhibited higher short- (OR 1.33; 95% CI 1.15–1.55; p < 0.001) and long-term mortality (OR 2.29; 95% CI 1.80–2.91; p < 0.001) rates. These outcomes were not driven by cardiovascular mortality (OR 1.30; 95% CI 0.70–2.40; p = 0.405) but were coupled with a higher incidence of major bleeding (OR 1.66; 95% CI 1.15–2.42; p = 0.008). Sensitivity analysis adjusted for confounders showed sustained higher mortality rates (aHR 1.77; 95% CI 1.33–2.34; p < 0.001), and patients with more advanced disease had even higher mortality rates (aHR 3.38; 95% CI 2.53–4.51; p < 0.001). However, there was no significant difference in stroke, myocardial infarction, acute kidney injury, or aortic valve gradient at a follow-up ranging from 180 days to 10 years. In summary, in this meta-analysis, 133,906 active cancer patients undergoing TAVR had higher short- and long-term mortality rates driven by non-cardiovascular causes and a higher incidence of major bleeding, with comparable rates of cardiac, renal, and cerebral complications. Therefore, the decision to proceed with TAVR should be individualized, considering cancer type, staging, and optimal timing for intervention.